CEDAR LAKE CAMPUS PHARMACY
NPI 1154321602
Pharmacy in West Bend, WI

Q: What is Benevolent Corporation Cedar Community's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Active since July 27, 2005

5595 COUNTY ROAD Z, WEST BEND, WI 53095(262) 306-2140(262) 306-2141 Get Directions Write a Review

NPPES record last updated: December 30, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 30, 2020, May 9, 2019, Dec 15, 2017 (3 updates tracked since 2017).

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About Cedar Lake Campus Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CEDAR LAKE CAMPUS PHARMACY (NPI 1154321602) is a healthcare organization registered as a pharmacy in West Bend, Wisconsin and active in the NPI registry since July 2005. The organization lists Joseph T Pichler, Vice President Of Finance, as its authorized official.

NPPES Registry Identity

NPI1154321602

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameBENEVOLENT CORPORATION CEDAR COMMUNITY

Location Address5595 COUNTY ROAD ZWest Bend, WI 53095-9224

Mailing Address5595 County Road ZWest Bend, WI 53095-9224 · (262) 306-2140 · Fax (262) 306-2141

Phone(262) 306-2140

Fax(262) 306-2141

Organization SubpartYes

Authorized OfficialJoseph T PichlerVice President Of Finance · (262) 306-4212

Enumeration DateJuly 27, 2005

Last NPPES UpdateDecember 30, 20203 updates tracked since enumeration

NPPES CertifiedDecember 30, 2020

✔ NPI 1154321602 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in WI · 5115503

Definition

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Also ListedPharmacy · Long Term Care PharmacyTaxonomy 3336L0003X · License 5115503 (WI)

5595 COUNTY ROAD Z, West Bend, WI 53095

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Other Names 1

Doing Business AsCedar Lake Campus Pharmacy

Other Identifiers 1

Medicaid33027100WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cedar Lake Campus Pharmacy is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by January 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateWisconsinEnrollment IDO20220124001935Non-DME Part B · PharmacyDue dateJanuary 31, 2027

Source: CMS Revalidation Due Date List, October 2026 release.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. AIMEE HODOROWSKI OTR

Occupational Therapist